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Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund * Texas Rural Water PAC
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Donation Information
Donation Amount *

NOTE:
The minimum donation amount is $5.00
The maximum donation amount is $1,000.00
Payment Method * Credit Card
Donor Occupation *
By typing my name, I certify that all of the following statements are true: *
* I was informed of my right to contribute without reprisal. My contribution is not made under any actual or threatened physical force, threat of job discrimination or financial reprisal, or as any condition of employment. * I was informed of eligibility requirements to be a Texas Rural Water PAC contributor. I understand that only executive, professional and managerial employees who are either U.S. citizens or noncitizens admitted to permanent residency may contribute to the Texas Rural Water PAC. I meet these requirements. * I was informed of the political purpose of the Texas Rural Water PAC. * I understand that any contribution guidelines are merely suggestions. * I understand that I am free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage me by reason of the amount of the contribution or the decision not to contribute.
I understand that corporate contributions are prohibited. *
We can only accept contributions from individuals. If we find that you have paid with corporate funds, we will send you notice and refund your credit card within 60 days.
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Billing Phone *

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